Journal of Medical Council of Iran
Year:2005 | Volume:23 | Issue:1|Papers Count:15

Iron deficiency anemia (IDA) is the commonest disorder due to malnutrition, and is an important health problem. This research determines. IDA prevalence and some associated factors in childbearing age (CBA) and non-childbearing age women in Guilan. Sample; comprised of 995 CBA women (15-49 years), selected in a multistage cluster-random sampling from the population mentioned. Data materials included a questionnaire, and blood examinations, and statistical analysis was performed by means of paired t-test. Anemia prevalence was 11.1%, IDA 7.6%, which was similar in both the urban and rural population, and showed significant correlation with parity (P<0.01) and age (P<0.0001).Ferrous sulfate has significant effect to increase hemoglobine in IDA subjects. IDA prevalence in Guilan is less than previous estimates, and Ferrous sulfate administration is effective in increasing hemoglobin levels.

Chronic monarthritis is one of the problems in the realm of rheumatology. Synovial biopsy (SB) plays an important role in the diagnosis of chronic monarthritis.In order to evaluate the diagnostic value of SB in identifying the cause of chronic monoarticular arthritis of knee, we retrospectively studied 100 patients (mean age: 35.3 year) admitted in rheumatology ward of Imam Khomeini Hospital. Monarthritis duration ranged between 4 to 6 months.After history taking, physical examination, laboratory and radiological studies, histopathological studies and culture had been performed in all of the biopsy samples.SBs were successfully performed in all of the patients without any complication. SB was able to indicate a definite diagnosis in 77 patients.The most common causes of chronic monarthritis were rheumatoid monarthritis (60 patients) and tuberculous monarthritis (10 patients).The present results revealed the safety and diagnostic value of SB in chronic monarthritis. Obviously, timely diagnosis of monarthritis leads to selective and effective treatment and prevention of articular complications in the form of osteoarthritis.

Diastematomyelia is a congenital anomaly of the spinal cord which is usually associated with other CNS, skeletal and skin abnormalities. In this study, 54 cases treated with surgical or medical routes have been surveyed. Average age was 35 months and female/male ratio was 18/1. Two thirds of the patients were found to have neurological deficit, with gait problem being the most predominant whereas skin and orthopedic anomalies ranked next. Tethered cord was detected in about half of them and spurs found in two third. Two thirds of cases underwent surgery out of whom 1/4 had transient postoperative complications with complication rate of 25%. There was no postoperative mortality. Post operative improvement of neurological deficit occurred in 14% of cases and same percentage had deterioration, while others had no change in their neurological status.

Diabetes Mellitus is a common disorder with numerous disabling complications, which can be largely prevented by simple, inexpensive interventions. The prevention of diabetic foot ulceration (DFU) is especially important because besides the morbidity and mortality it entails time and a heavy financial burden. In order to study the prevalence of lower limb amputations, this study was designed in patients admitted with diabetic foot ulcerations.This retrospective descriptive study was carried out at Imam Khomeini and Dr. Shariati University Hospitals in Tehran. Data pertaining to 281 patients admitted between 1979 and 2001 for treatment of diabetic foot ulceration was collected and analyzed using SPSS software.Over the 22-year period of the study, 281 patients (61% men and 39% women) were hospitalized for DFU. The overall lower limb amputation rate was 30%. Mean hospital stay was significantly longer in patients who eventually underwent amputation than in those who did not. The rate of lower limb amputation secondary to DFU is higher in Iran than the global average. This necessitates greater attention and better planning with regards to the prevention and treatment of DFU.

Previous studies demonstrated the efficacy of carotid endarterectomy (CEA) in reducing the risk of strokes, and deaths in selected patients afflicted with carotid artery stenosis. Selection of patients for CEA depends on degree of stenosis, whether patient is symptomatic or asymptomatic and complication rate of CEA; so, it has been recommended that surgical departments publish their complication rates. As there were no data regarding complication rates of CEA in Iran, this study was performed. We performed a retrospective study of all CEAs performed in Taleghani and Iranmehr hospitals till March 200. In-hospital mortality or strokes were determined by review of patients' files. Telephone interview of patients or their families achieved additional follow-up for complications occurring within 30 days of CEA. The cohort consisted of 246 consecutive cases of CEA. There were 12 (6.4%) strokes and 4(2.1%) deaths in Iranmehr and 2(3.4%) strokes and 3(5.2%) deaths in Taleghani hospitals. Overall complication rate was 8.5%. Risk factors for stroke or death were history of diabetes mellitus and, unexpectedly, history of previous CEA on contra lateral side. According to the results of this study, CEA is appropriate for symptomatic patients with stenosis greater than 70% and not recommended for asymptomatic patients. Determining complication rates of CEA in other centers will help the selection of appropriate patients for CEA.

Stress is undoubtedly one of the best known factors that threatens the health of an anesthesiologist. There are few quantitative measures about the job-related stress in anesthesiology. This study attempts to determine these job-related stressors, measure them quantitatively and rank them.In this cross-sectional study after reviewing the literature and extraction of stressors to which anesthesiologists and residents are exposed, a primary list of occupational problems (30 questions) was compiled. In phase I, 39 registered residents (group A) answered the questionnaire before beginning their program. Then the questionnaire was revised slightly based on phase I experiences and a final version of the questionnaire (34 questions), was completed by 85 first- to third- year residents in phase II. To assess the reliability of the questionnaire, Cronbach was calculated for groups A and B as 0.929 and 0.927 respectively. ANOVA was highly significant (P<0.0001) after data collection, answers were ranked zero to four and mean score for each resident was calculated. Then we averaged these mean scores and named it: "Anesthesiology problem score (APS)". Besides, all residents completed SCL-90R screening test questionnaire and we extracted its nine subscales. In group A, "financial problems" and "vague career future" and in group B, "vague career future" and "inadequate training of residents" were ranked as the most important problems. In both groups, "fear of addiction" was the least important problem. To measure the relationship between APS and nine Scl-90R subscales, parametric correlation test was performed. This relationship appeared significant for all subscales (P<0.02) .Besides, T-test for independent groups showed significant difference in APS between two sex groups (1.21 for men and 1.51 for women, P=0.04). One- way ANOVA showed significant difference in APS among educational years (P=0.04). We conclude that: "anxiety about career future" is the most important occupational stressor among young anesthesiologists. Statistical tests show the relationship between occupational stress and the following: 1. SCL-90R Scores, 2- The extent of work experience. In addition these tests demonstrate that stressors are different in quality and quantity among men and women.

Unemployment which had been a problem of less educated and unskilled people, has become a problem in most of the countries for even the educated and the skilled persons. Unemployment among physicians in Iran has been the subject of discussion during the past so many years, and its severity, causes and ways of combating it has been a focus of discussions in different circles.It is a mail survey conducted on random sample, sized 5482 physicians, from registered physician roster at the medical Association of Islamic Republic of Iran. The questionnaire included items on employment and unemployment quality and some related factors. The final analysis is based on the 2789 returned questionnaires.Total unemployment has a point prevalence of 9.4% among Iranian physicians (95% CI: 8.3% - 10.5%). When summed with physicians with qualitative unemployment, this figure reaches 13.7% (95% CI: 12.4% - 14.9%). Considering quantitative unemployment, the total ratio reaches 25.5%. Half of the unemployed physicians have seeked jobs for more than a year, and they mostly attribute their failure to low income of medical jobs and limited positions for physicians in the governmental sector.Unemployment, in different forms from total to qualitative and quantitative forms affects from one-tenth to one fourth of Iranian physicians. This problem is not limited to Iran, but has been seen in many other countries, especially those that had increased the strength of their medical students in the past. The solution of this problem needs its accurate identification and factors affecting it or related to it. Solving this problem needs finding its accurate fissure and the related factors.

Cow's milk allergy (CMA) is an immunologic phenomenon to the proteins present in Cow's milk. It frequently appears with gastrointestinal (GI) problems such as abdominal pain, diarrhea and bloody stool. Its frequency is about 1.9 - 7.5% and symptoms usually appear in early months of life. In this study, we assess CMA in infants with rectorrhagia. In this study infants (<2yrs) with complaints of rectorrhagia reporting at the children's clinic at Imam Khomeini Hospital were included. Inclusion criteria comprised of parents' report of passage of bloody stools, absence of infection and local conditions such as anal fissure, acidic PH and lactase deficiency. Then formal consents were taken, skin prick test and open food challenge test were performed. Those who were refractory to diet without cow's milk protein, were assessed by colonoscopic procedure. Among 198 infants with rectorrhagia, 51 patients were eligible for this study (41% boys, 58.8% girl & with mean age of 5.3 month). Besides rectorrhagia other manifestation was: diarrhea (80%), abdominal pain (56.9%), atopic dermatitis (21.6%) and recurrent vomiting (10%). Skin prick test were done in 37 cases which was positive in 18 pts. 47 patients had positive challenge tests, in 4 patients with negative challenge test was colonsopy performed. Two cases had nodularity with eosinophilic infiltration, allergic were reported in the others. All patients (including these 4 cases) reponded well to exclusion diet. It has been shown in this study that Cow's Milk Allergy (CMA) has a significant prevalence in infants (<2 yrs ) with rectorrhagia. The definite diagnosis is made by challenge test and the treatment is exclusion diet. According to the results, it is recommended that CMA should be taken in to consideration in children exhibiting gastrointestinal symptoms.

Gypsy way of life is a nomadic life adopted by a group of people because of their liking for migration and contact with other societies to earn their livelihood. The prevalence of Hepatitis B in a small population of gypsies residing in the South West of Iran is the main purpose of this study. This study has performed as screening for hepatitis B in a community of gypsies (226 persons). The obtained serums in the first step were tested for serologic markers of HBsAg, Anti -HBc for Hepatitis B virus (HBV).All positive cases were tested again for HBsAg, Anti-HBs, HBeAg, Anti-HBe, Anti-HBc in the second step. Serologic results indicated that 54 individuals (20.5%) were positive for one or more HBV markers so that, 22 of them (%9.6 of overall) had infectious hepatitis B, 13 of them (%5.8 of overall) were only HBsAg positive, 11 individuals (%4.9 of overall) were improved and in immune state and 8 persons had Isolated Anti-HBc antibody. The prevalence and relative risk of HBV in these persons has been found to be much higher than the normal population. (RR=10, P<0.001).In societies like gypsies, who have various contacts with different groups and harboring habits like tatooing, causes an increased prevalence of diseases like HBV. Circulation of HBV infection among such societies in such surveys reveals serologic variations. In fact various serologic patern of infection from the beginning of infection to end of infection (like cured, immune, chronic, carrier cases) could be achieved at one time.

Atherosclerosis is a important agent of mortality and morbidly among humans. Knowledge of the causative and precipitating factors of atherosclerosis is therefore highly important.Among the factors, infections have been cited among which Chlamydia pneumoniae. Accordingly we performed a systemic dissection of the 3 coronary arteries and ascending aorta in 49 postmortem subjects who underwent operation and 5 atherosclerotic plaques in alive subjects and studied the relationship in individual persons between the presence of Chlamydia pneumoniae DNA and the number of major risk factors. Other major risk factors comprising age, sex, blood pressure, diabetes mellitus, smoking, hypercholestrolemia and history of deaths due to heart ailment in families were also studied.From each vessels, two sections were obtained, one determining pathological grading of atherosclerosis (study classification), and other determining the prevalence of Chlamydia pneumonia DNA by polymerase chain Reaction (PCR) method. PCR was performed in Pasteur Institute.C.Pneumoniae was detected by PCR in 14 (25.9%) out of 54 subjects.19 segments of vessels were positive for C. Pneumoniae out of which 16 segments (84.2%) had atherosclerosis and an equal or more than 3 in pathologic gradings. In the C. Pneumoniae positive patients, in comparison of the two groups comprising of patients with one or more risk factors, no statistically significant difference was seen (P>0.05). This study opens up the path for management strategies in eradicating C. Pneumoniae, and decreasing morbidity, mortality secondary to atherosclerosis.

Hydatid cyst of the heart is a rare disease which seems endemic among rural areas and countries exporting muttow.The established theory regarding heart involvement in hydratid cyst is because of involvement of the coronary arteries due to Echinococcus granulosis disease.Here a case is reported where hydatid cyst initially affected the areas adjacent to the pulmonary valve, later spreading to the right and left pulmonary arteries and eventually metastasizing to both lungs, and because of this rare course, this spread in this patient could be considered as a retrograde spreed (from heart to lungs).The site of origin and the spread reises this question as to whether E.granulosa can directly station itself at the pulmonary valve and resist the blood current and thus produces the mother cyst at that particular site.

An early diagnosis of gynecological caner is a life saving measure in ensuring a woman's health. It is important that the current knowledge about screening and timely diagnosis of premalignant and malignant conditions are ensured for physicians, the necessity of widespread use of screening is due to its high sensitivity, specificity, low cost and its non invasiveness. Cervical cancer is one of the gynecological cancers where screening programs have resulted in a reduction in morbidity and mortality secondary to this disease, in endometrial cancer, as the patient usually reports during the initial phase of the disease; screening is only useful in the high risk group. Ovarian cancer is another gynecological caner in which considerable research is going on to find an appropriate screening Techniques. In this article we would discuss the varying screening techniques available for gynecological caners.